Monday, March 07, 2011

Racial Inequity in Deceased Donor Kidney Transplants

A recent study published in the Journal of American Society of Nephrology explores the reasons behind the ethical/racial disparities in obtaining a deceased donor kidney (time and incidence of waitlisting, time spent on waitlist, transplants, etc).

The researchers looked at over 500,000 non-elderly* adults who began dialysis between 1995 and 2006, examining measurable factors and how it affected access to transplantation.

Health insurance coverage and poverty were the biggest factors in disparity of transplant rates among blacks (17.9%), Hispanics (14.3%), and American Indians (23.2%). <- And yet another reason to fix our mucked up health care system in the US.

Geographic variation in organ availability was an important factor among Hispanics (13.5%) and Pacific Islanders (19.1%) <- And yet another reason why UNOS/OPTN must eliminate regions and DSAs, making our system truly national.

Household linguistic isolation, meaning an inability to speak english affected Hispanics (7.0%) and Pacific Islanders (6.2%). Linguistic isolation had little effect among blacks and AIANs. <- Just a note for those folks who think it's Un-PC to expect folks living in a country to speak the native language: one's life may depend on it.

The effect on delay to transplantation attributed to measured factors ranged from 8% in blacks to 78% in Hispanics**. <- Let this sink in for a second. Whether or not a Hispanic person in the US will obtain a kidney from the waitlist is 78% determined by insurance, poverty, location, language, etc. Yet some people insist we have no social classes in this country. Okay.





*I'm not certain what the age cut-off is for this term. Unfortunately, I couldn't access the full and entire study.

**This statistic is from a medscape article on the study, where the study abstract says:

The fraction of the reduced transplant rates attributable to measured factors (e.g., demographic, clinical, socioeconomic, linguistic, and geographic factors) varied from 14% in blacks to 43% in American Indians/Alaska Natives compared with whites


Hall YN, Choi AI, Xu P, O'Hare AM, & Chertow GM (2011). Racial Ethnic Differences in Rates and Determinants of Deceased Donor Kidney Transplantation. Journal of the American Society of Nephrology : JASN PMID: 21372209